Cognitive Behavioral Therapy for Insomnia in Postpartum Depression: A Meta-Analysis of Therapeutic Outcomes and Barriers to Clinical Use

Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia in the general population and pregnant women. However, its effects on postpartum depression remain underexplored. Objectives of this meta-analytic review were to evaluate the effects of CBT-I on postpartum depression, insomnia severity, and total sleep time in perinatal women. PubMed, ScienceDirect, and Google Scholar databases were searched. Randomized controlled trials with perinatal women, CBT-I as intervention, and comparison with any other intervention were included. Bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool. Four studies were deemed eligible, with a combined sample size of 381 participants. Insomnia severity, postpartum depression, and total sleep time were selected as outcomes. Mean differences were calculated with 95% confidence interval (CI), and heterogeneity was assessed using I2 statistics. For insomnia severity, a mean difference of -2.30 (95% CI: -4.10 to -0.49, P = 0.0126) was obtained, favoring the CBT-I group. For postpartum depression, a standardized mean difference of -0.20 (95% CI: -0.40 to 0.00; P = 0.0502) showed borderline statistical significance, also favoring the CBT-I group. However, for total sleep time, a mean difference of 0.44 (95% CI: -0.04 to 0.92; P = 0.075) with 66% heterogeneity showed nonsignificant results, mainly due to an outlier study. With this outlier study, the heterogeneity dropped to 0%, the mean difference increased to 0.68 (95% CI: 0.37-0.99), reaching statistical significance (P < 0.0001). This meta-analysis demonstrates that CBT-I significantly reduces insomnia severity and improves total sleep time in perinatal women, with a borderline significant reduction in postpartum depression scores. Despite its growing evidence, it remains an underutilized treatment option. By incorporating it, the overall quality of maternal healthcare services can be improved.